Bobby Mukkamala, MD

President, American Medical Association

Removing stigmatizing language on Colorado’s medical licensing application is essential to support physicians at every stage of their careers. 

The Colorado Legislature agreed to that premise last year by enacting Colorado House Bill 25-1176. This law ensures that the Colorado medical licensing application is free from stigmatizing and inappropriate questions requiring physicians to disclose whether they have ever sought treatment for a mental illness or substance use disorder when there is no current impairment. 

Colorado’s law is one of about a dozen nationwide to require licensing boards to take such action. For Colorado, the law marked the successful conclusion to advocacy championed by the Colorado Academy of Family Physicians (CAFP) and strongly supported by the Colorado Medical Society (CMS), the Colorado Chapter of the American College of Emergency Physicians, the Colorado Psychiatric Society, the American Medical Association (AMA) and others. The bill passed with overwhelming, bipartisan majorities. 

Enactment was not the end of the journey, however. In fact, the AMA, CMS, CAFP and the Dr. Lorna Breen Heroes’ Foundation (LBF) continue to engage with the Department of Regulatory Authorities (DORA) to provide technical assistance on the types of changes needed to ensure that the updated licensing application follows the new law. The AMA regularly engages with licensing boards, hospitals and health systems to provide this type of close analytical support. You can check the LBF website (drlornabreen.org/credentialing/#colorado) for the hospitals and health systems where AMA and LBF advocacy has been successful. 

DORA, which has told CMS and CAFP that it is still working on the necessary updates, had two main issues with its applications that needed correction. The first was the need to revise a question asking if an applicant (new or renewal) had any impairment within the past five years. 

On one hand, the AMA supports the disclosure of an impairment that has a current, adverse impact on patient safety and the physician’s ability to provide safe, competent care. On the other hand, the AMA is part of a large coalition that does not support a lookback that would require disclosure of prior or current treatment when there is no current impairment. This is due to many factors, including that past history of treatment or impairment is not indicative of current lack of fitness to practice medicine.

This was codified in HB 25-1176, which reads in part: “The application must not require the disclosure of personal medical or health information that is not relevant to the applicant’s ability at the time of application to provide safe, competent, and ethical care.”

HB 25-1176 also requires that “The application must not include information about past health-related conditions…that do not impact an applicant’s ability to practice safe, competent, and ethical patient care at the time of application.”

Taken together, the AMA, LBF, CAFP, CMS and others held detailed calls with DORA to walk through our recommendations, and we also provided them in writing after the call – steps that are an essential part of the advocacy process.

The AMA and our partners also recommended slight changes to the format of the application so that there are distinctions in the placement of questions related to adverse actions (e.g., “Have you ever been arrested?”) compared to questions about health status (e.g., “Do you have a current impairment?”). 

If these changes appear to be highly nuanced and technical, they are. The essence of the detailed and active legislative and regulatory advocacy undertaken by the AMA, CMS and CAFP involves focusing on every period, comma, word and phrase in a piece of legislation or the regulations to implement laws. This includes the medical licensing applications we complete every few years.

Details, words, and format all matter – and careful attention to each is an essential element of the AMA’s national campaign to support the health and wellbeing of medical students, residents, and physicians.

At the time of this article, DORA said it was still working on the necessary updates – and the AMA, CAFP and CMS are urging them to complete their work as swiftly as possible.